Influence of Comorbidities on Colorectal Cancer Screening Participation and Mortality

Area of Science:

• Oncology
• Public Health
• Clinical Medicine

Background:

• Colorectal cancer (CRC) screening programs aim to increase participation.
• Patient-level factors can influence CRC screening deferral.
• Fecal immunochemical tests (FIT) are a common screening method.

Purpose of the Study:

• To examine patient-level factors associated with CRC screening deferral.
• To investigate the relationship between laboratory abnormalities and FIT orders and completion.
• To assess the impact of screening deferral on long-term mortality.

Main Methods:

• A cohort of 76,967 patients aged 50-75 years not up-to-date with CRC screening were followed.
• Patient laboratory data and cancer registry data were analyzed.
• Patients with specific laboratory abnormalities were compared to those without regarding FIT orders, completion rates, and 8-year mortality.

Main Results:

• 1053 out of 9676 eligible patients had laboratory abnormalities.
• Patients with abnormalities were less likely to have FIT orders (39.5% vs 66.8%) and complete screening (21.5% vs 51.6%).
• Laboratory abnormalities were associated with significantly higher 8-year mortality (32.6% vs 6.7%).

Conclusions:

• Laboratory abnormalities correlate with reduced FIT orders and completion, indicating potential provider-initiated screening deferral.
• Higher mortality in patients with abnormalities underscores the negative impact of deferred screening.
• Future research should explore how electronic health data can inform screening service implementation and address provider-level barriers.